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Dka In Pregnancy Ppt

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This video relates abdominal pain according to different abdominal regions and states the most important differential diagnosis of each pain position.

Exam Shows Diffuse Abdominal Tenderness With Guarding.

A 14 y/o female is brought to the emergency department by her mother after being found unresponsive at home. She had been ill the day before with nausea and vomiting, but was not running a fever. Her parents had kept her home from school that day. When her mother came home at lunchtime to check on her, she was very lethargic and not responding coherently. By the time she arrived at the hospital, she had to be brought in to the ED on a gurney. Initial evaluation showed O2 sat 100% on room air, pulse 126, respirations 30, BP 92/68, temperature 101.2 F. She appears pale, mucous membranes are dry and she only responds to painful stimuli. Exam shows diffuse abdominal tenderness with guarding. Differential diagnosis? What initial treatment would you suggest? What labs would you order? Any xrays or additional studies? CBC WBC 23,500 Hgb 14.2 g/dL Hct 45% Platelets 425,000 BMP Sodium 126 Potassium 5.2 Chloride 87 CO2 <5 BUN 32 Creatinine 1.5 Glucose 1,376 Arterial Blood Gases pH 7.19 Po2 100 mm Hg HCO3 7.5 mmo/L Pco2 20 mm Hg Sao2 98% (room air) Urine Specific gravity 1.015 Ketones 4+ Leukocytes few Glucose 4+ Nitrates 0 RBCs many Diabetic ketoacidosis (DKA) is an acute metabolic complicat Continue reading >>

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  1. Carolyn B

    High fasting blood sugar on keto

    Hi. I was diagnosed with pre-diabetes in November 2016. My brother has Type 2 so I knew I had to do something to stop my pre-diabetes from progressing I started to eat low carb and saw a slow reduction in my BS numbers. Then a month or so ago I started adding fat to my diet and am now eating keto. I am in low ketosis (urine test). My daily carb intake is approximately 40-60 grams.
    The results have been nothing short of miraculous! I've lost 17 pounds, my triglycerides have plummeted from 240 to 60, BP is way down, cholesterol dropped. All of my numbers look better than they have my entire adult life. My body seems to love this way of eating. It's been amazing and not difficult at all!
    My A1C went from 5.9 to 5.4. I am guessing it's around 5.2 now but I haven't tested since I went full keto. My only problem is that my morning fasting number has inched up. It was 95-99 when I was diagnosed. Then when I started to change my diet it dropped to the 88-95 range. After I started keto it's moved up to the 100-105 range. I'd like to work on getting this number down. My one and two hour post meal numbers are good, usually in the 100-120 range. Any suggestions on how I can lower the fasting number?
    Thanks so much.

  2. jdm1217

    Originally Posted by Carolyn B
    Hi. I was diagnosed with pre-diabetes in November 2016. My brother has Type 2 so I knew I had to do something to stop my pre-diabetes from progressing I started to eat low carb and saw a slow reduction in my BS numbers. Then a month or so ago I started adding fat to my diet and am now eating keto. I am in low ketosis (urine test). My daily carb intake is approximately 40-60 grams.
    The results have been nothing short of miraculous! I've lost 17 pounds, my triglycerides have plummeted from 240 to 60, BP is way down, cholesterol dropped. All of my numbers look better than they have my entire adult life. My body seems to love this way of eating. It's been amazing and not difficult at all!
    My A1C went from 5.9 to 5.4. I am guessing it's around 5.2 now but I haven't tested since I went full keto. My only problem is that my morning fasting number has inched up. It was 95-99 when I was diagnosed. Then when I started to change my diet it dropped to the 88-95 range. After I started keto it's moved up to the 100-105 range. I'd like to work on getting this number down. My one and two hour post meal numbers are good, usually in the 100-120 range. Any suggestions on how I can lower the fasting number?
    Thanks so much. I've been there at times and I don't even worry about it, especially if your A1C is still good.

  3. Nicoletti

    Originally Posted by Carolyn B
    My one and two hour post meal numbers are good, usually in the 100-120 range. Any suggestions on how I can lower the fasting number? Give it more time. Fasting numbers are usually the last to come down. It took me about a year of low-carb eating to get fastings in the 80s, and that's common for others here, too; it takes time.

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What is ENDOCRINOLOGY? ENDOCRINOLOGY meaning - ENDOCRINOLOGY pronunciation - ENDOCRINOLOGY definition - ENDOCRINOLOGY explanation - What does ENDOCRINOLOGY mean? How to pronounce ENDOCRINOLOGY? Source: Wikipedia.org article, adapted under https://creativecommons.org/licenses/... license.

Department Of Endocrinology, Diabetes, Metabolism

Dr. Kanakamani Madhivanan, M.D., D.M. (Endocrinology), Assistant Professor Christian Medical College, Vellore Introduction Global increase in prevalence of DM Individual importance - Hyperglycemia in pregnancy has adverse effects on both mother and fetus Public health importance – rising epidemic of DM in part attributed to the diabetic pregnancies Prevention of type 2 DM should start intrauterine and continue throughout life Introduction Gestational diabetes (GDM) is defined as any degree of impaired glucose tolerance of with onset or first recognition during pregnancy . Many are denovo pregnancy induced Some are type 2 ( 35-40%) 10% have antibodies Introduction Difficult to distinguish pregestational Type 2 DM and denovo GDM Fasting hyperglycemia blood glucose greater than 180 mg/dL on OGT acanthosis nicgrans HbA1C > 5.3% a systolic BP > 110 mm Hg BMI > 30 kg/m2 Fetal anomalies Clues for Type 1 Lean DKA during pregnancy Severe hyperglycemia with large doses of insulin Fuel metabolism in pregnancy Goal is uninterrupted nutrient supply to fetus The metabolic goals of pregnancy are 1) in early pregnancy to develop anabolic stores to meet metabolic demands in late pregnancy 2) Continue reading >>

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  1. One of our CDI noted an elevated lactic acid and queried the physician for a diagnosis. The patient did not have Sepsis. Our physician advisor said not to do that because the next lactic acid was normal. She said we should also be looking for the underlying cause of the lactic acidosis and not querying for the diagnosis. A diagnosis of lactic acidosis will give us a CC. Other CDI's have said that if the elevated lactic acid was treated, monitored or evaluated we should be querying for the diagnosis. Does anyone have any direction on how this should be handled?
    Is lactic acidosis always inherent in other conditions and that's what we should focus on?
    What can we pick up the diagnosis by itself as a CC / when should we query to get to documented in the chart?
    Are there any other clinical parameters we should be looking at when evaluating whether we should query such as the anion gap?
    Is there a specific treatment for metabolic acidosis?
    Thank you,
    Christine Butka RN MSN
    CDI Lead
    CentraState Medical Center
    Freehold, NJ

  2. What a timely comment. Recently, our coding auditor suggested that we should always keep an eye out for the cc "acidosis". It seems to me that lactic acidosis could be inherent to the disease process of sepsis and therefore should not be captured. Any thoughts?
    Yvonne B RN CDI Salinas, CA.

  3. Hello all! I agree, I believe lactic acidosis is inherent to sepsis. It is one of the most important indicators that gives the clnician a clue that sepsis may be present. Our fluid administration policy was actually developed on the lactic acid result: the higher the number, the more fluid we bolused (in non-CHF patients, of course). In cases were Sepsis is determined not to be present, we will query the provider, providing they treated or monitored the acidosis in some manner
    Shiloh

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What is DIABETIC KETOACIDOSIS? What does DIABETIC KETOACIDOSIS mean? DIABETIC KETOACIDOSIS meaning - DIABETIC KETOACIDOSIS definition - DIABETIC KETOACIDOSIS explanation. Source: Wikipedia.org article, adapted under https://creativecommons.org/licenses/... license. SUBSCRIBE to our Google Earth flights channel - https://www.youtube.com/channel/UC6Uu... Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes mellitus. Signs and symptoms may include vomiting, abdominal pain, deep gasping breathing, increased urination, weakness, confusion, and occasionally loss of consciousness. A person's breath may develop a specific smell. Onset of symptoms is usually rapid. In some cases people may not realize they previously had diabetes. DKA happens most often in those with type 1 diabetes, but can also occur in those with other types of diabetes under certain circumstances. Triggers may include infection, not taking insulin correctly, stroke, and certain medications such as steroids. DKA results from a shortage of insulin; in response the body switches to burning fatty acids which produces acidic ketone bodies. DKA is typically diagnosed when testing finds high blood sugar, low blood pH, and ketoacids in either the blood or urine. The primary treatment of DKA is with intravenous fluids and insulin. Depending on the severity, insulin may be given intravenously or by injection under the skin. Usually potassium is also needed to prevent the development of low blood potassium. Throughout treatment blood sugar and potassium levels should be regularly checked. Antibiotics may be required in those with an underlying infection. In those with severely low blood pH, sodium bicarbonate may be given; however, its use is of unclear benefit and typically not recommended. Rates of DKA vary around the world. About 4% of people with type 1 diabetes in United Kingdom develop DKA a year, while in Malaysia the condition affects about 25% a year. DKA was first described in 1886 and, until the introduction of insulin therapy in the 1920s, it was almost universally fatal. The risk of death with adequate and timely treatment is currently around 1–4%. Up to 1% of children with DKA develop a complication known as cerebral edema. The symptoms of an episode of diabetic ketoacidosis usually evolve over a period of about 24 hours. Predominant symptoms are nausea and vomiting, pronounced thirst, excessive urine production and abdominal pain that may be severe. Those who measure their glucose levels themselves may notice hyperglycemia (high blood sugar levels). In severe DKA, breathing becomes labored and of a deep, gasping character (a state referred to as "Kussmaul respiration"). The abdomen may be tender to the point that an acute abdomen may be suspected, such as acute pancreatitis, appendicitis or gastrointestinal perforation. Coffee ground vomiting (vomiting of altered blood) occurs in a minority of people; this tends to originate from erosion of the esophagus. In severe DKA, there may be confusion, lethargy, stupor or even coma (a marked decrease in the level of consciousness). On physical examination there is usually clinical evidence of dehydration, such as a dry mouth and decreased skin turgor. If the dehydration is profound enough to cause a decrease in the circulating blood volume, tachycardia (a fast heart rate) and low blood pressure may be observed. Often, a "ketotic" odor is present, which is often described as "fruity", often compared to the smell of pear drops whose scent is a ketone. If Kussmaul respiration is present, this is reflected in an increased respiratory rate.....

Chapter 11: Diabetic Ketoacidosis In Pregnancy

Despite recent advances in the evaluation and medical treatment of diabetes in pregnancy, diabetic ketoacidosis (DKA) remains a matter of significant concern. The fetal loss rate in most contemporary series has been estimated to range from 10% to 25%. Fortunately, since the advent and implementation of insulin therapy, the maternal mortality rate has declined to 1% or less. In order to favorably influence the outcome in these high-risk patients, it is imperative that the obstetrician/provider be familiar with the basics of the pathophysiology, diagnosis, and treatment of DKA in pregnancy. DKA is characterized by hyperglycemia and accelerated ketogenesis. Both a lack of insulin and an excess of glucagon and other counter-regulatory hormones significantly contribute to these problems and their resultant clinical manifestations. Glucose normally enters the cell secondary to the effects of insulin. The cell then may use glucose for nutrition and energy production. When insulin is lacking, glucose fails to enter the cell. The cell responds to this starvation by facilitating the release of counter-regulatory hormones, including glucagon, catecholamines, and cortisol. These counter-regula Continue reading >>

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  1. jcpryor3

    Cyclical Ketogenic Diet + Intermittent Fasting

    Hey everyone! I was wondering how I would go about implementing the CKD and IF. I kinda have an idea, but I'm not to sure. I plan on using a workout routine designed for CKD. In one of the Keto forums, there is a thread from Blindfaith titled, "Step By Step Keto Diet Plan." I will be using the workout from that thread most likely, if not, something fairly similar.
    I'm guessing I would need to follow some of the keto guidelines (i.e. 65% fat, 30% protein, 0-5% carbs, as well as carb refeeeding during the weekends) and some IF guidelines (i.e. 16/8, 10g bcaa pre-workout). Monday through thursday I would be doing IF, while implementing keto guidelines mentioned above to enter ketosis. Friday will be my depletion workout followed by a carb refeed. I understand that a carb refeed lasts anywhere from 24-36hrs, starting Friday evening and ending Saturday at midnight. Correct me if I'm wrong because I've been doing a lot of research lately and still trying to process it all so I can get the ball rolling finally. Anyways, fridays and saturdays would be used strictly for carb refeeding, which would mean that I have to ditch IF starting friday evening until saturday at midnight. I would begin IF again starting Sunday morning.
    What I need to know is if this would work out. Thoughts, input, and concerns are all welcome. Thank you in advance!

  2. KLMARB

    Originally Posted by jcpryor3
    Hey everyone! I was wondering how I would go about implementing the CKD and IF. I kinda have an idea, but I'm not to sure. I plan on using a workout routine designed for CKD. In one of the Keto forums, there is a thread from Blindfaith titled, "Step By Step Keto Diet Plan." I will be using the workout from that thread most likely, if not, something fairly similar.
    I'm guessing I would need to follow some of the keto guidelines (i.e. 65% fat, 30% protein, 0-5% carbs, as well as carb refeeeding during the weekends) and some IF guidelines (i.e. 16/8, 10g bcaa pre-workout). Monday through thursday I would be doing IF, while implementing keto guidelines mentioned above to enter ketosis. Friday will be my depletion workout followed by a carb refeed. I understand that a carb refeed lasts anywhere from 24-36hrs, starting Friday evening and ending Saturday at midnight. Correct me if I'm wrong because I've been doing a lot of research lately and still trying to process it all so I can get the ball rolling finally. Anyways, fridays and saturdays would be used strictly for carb refeeding, which would mean that I have to ditch IF starting friday evening until saturday at midnight. I would begin IF again starting Sunday morning.
    What I need to know is if this would work out. Thoughts, input, and concerns are all welcome. Thank you in advance!

    Yes, it will work well. The reason IF works well with a ketogenic/sustained lipolytic nutritional pattern is that there is no significant amount of glycogen storage (except during recompensation periods) which acts as a buffer that interferes with sustained and adapted lipolysis. That's why IF combined with a carb-based cut often shows little advantage, due to the constant presence of glycogen, depending upon types and amounts of carbs consumed...

  3. jcpryor3

    If I'm understanding you correctly, your saying that IF + CKD work great together right? And IF complimented with a carb based diet has little advantage due to higher glycogen stores right?

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